That changed on Dec. 20, when the Centers for Medicare & Medicaid Services issued the Exchange Program Integrity final rule.
One of its new provisions concerns health insurance exchange plans set up under the Affordable Care Act and covering elective abortions—procedures which under federal law cannot be funded with federal funds.
These plans must now send customers separate health insurance bills for abortion coverage. The agency justified the rule on the grounds that it better aligns with congressional intent in segregating payments for elective abortion.
The rule appears to allow consumers to avoid payment on the surcharge without losing coverage. The fact sheet for the rule states “if the policy holder fails to pay the separate bill in a separate transaction as instructed by the issuer, the issuer may not terminate the policy holder’s coverage on this basis, provided the amount due is otherwise paid.”
Critics have long argued that enforcement of these regulations under the Obama administration was so permissive as to render the rules meaningless. A Government Accountability Office report in 2014 found that many insurers were ignoring requirements to segregate abortion coverage funds.
The Trump administration rule had been proposed about a year ago, but it had not been finalized and implemented.
Marjorie Dannenfelser, president of the Susan B. Anthony List, said the rule “will ensure compliance so that 'separate' no longer means 'together' when it comes to funding abortion.” The law will “provide transparency about abortion funding hiding in Obamacare,” she said, referring to the 2010 health care legislation.
“President Trump has delivered an important victory for American consumers and taxpayers, the majority of whom oppose using tax dollars to pay for abortions.”
Jacqueline Ayers, vice president of government relations and public policy at Planned Parenthood, opposed the rule on the grounds it tried to reduce access to abortion.
“This rule won't just require separate payments, it further splits off abortion from other reproductive health care and puts up massive barriers to access,” she said.
Ayers added that Planned Parenthood, which is the largest abortion provider in the U.S., “vehemently opposes this rule and will continue our work to stop the administration's attacks on our health and rights.”
The Association for Community Affiliated Plans, which has 60 Medicaid-focused health care plans, also opposed the rule, CNN reports.
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“Requiring people to pay two bills for one product -- health coverage -- is a non-solution in search of a problem,” said Margaret Murray, the association's CEO.
Critics of the previous rule have sought change under the Trump administration. In 2018 U.S. Rep. Chris Smith (R-N.J.), in a letter to the Department of Health and Human services signed by 102 Members of Congress, requested regulations to make consumers aware of the surcharge.
In October 2019, more than 40 pro-life organizations sent a letter to the Trump administration backing the new changes. Signers included leaders with the Susan B. Anthony List, the National Right to Life Committee, March for Life Action, Americans United for Life, and the American Association of Pro-Life OB-GYNS.
They said that insurance companies could create “hidden abortion surcharges” which mean health plan enrollees are “unknowingly paying into plans that subsidize elective abortion.”
Their letter cited the Hyde Amendment, first passed in 1976, which bars federal funding for most abortions. They objected that the treatment of abortion coverage violates the amendment in principle. Requiring separate payments would help provide transparency.
While the Hyde Amendment applies to federal health care programs including Medicaid, pro-life advocates have voiced concern for years that the Affordable Care Act does not follow its requirements.